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Ann Thorac Surg 2002;74:S1781-S1785
© 2002 The Society of Thoracic Surgeons

Session 1: Ascending Aorta

Replacing the ascending aorta and aortic valve for acute prosthetic valve endocarditis: is using prosthetic material contraindicated?

Christian Hagl, MDa*, Jan D. Galla, MD, PhDa, Steven L. Lansman, MD, PhDa, Daniel Fink, MDa, Carol A. Bodian, DrPHb, David Spielvogel, MDa, Randall B. Griepp, MDa

a Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York, USA
b Biomathematics, Mount Sinai School of Medicine, New York, New York, USA

* Address reprint requests to Dr Hagl, Division of Thoracic and Cardiovascular Surgery, Hanover Medical School, Carl-Neuberg-Strasse 1, Hanover 30625, Germany
e-mail: chagl{at}hotmail.com

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

Abstract

BACKGROUND: The use of prosthetic material (rather than a homograft) for ascending aorta/aortic valve replacement (Bentall procedure) in cases of acute prosthetic valve endocarditis is controversial. We report favorable results using this technique almost exclusively (a homograft was used in only 3 patients with hematological problems) during a 12-year interval.

METHODS: Twenty-eight patients (55 ± 14 years; 22 male) underwent a Bentall procedure for acute prosthetic valve endocarditis between 1988 and 2000. Twenty-five patients had undergone previous aortic valve replacement (1 with concomitant mitral valve replacement, 4 with coronary artery bypass grafting), and 3 had had a previous Bentall operation. The median interval between initial surgery and reoperation was 13 months (range, 1 to 106). Sixty-eight percent of operations were urgent or emergencies. Ninety-three percent of patients had significant aortic regurgitation; complete annuloaortic dehiscence occurred in 71%, and in 57%, an abscess was found. Causative organisms were identified in 25 of 28 patients: Staphylococcus epidermidis (9), Staphylococcus aureus (7), Streptococcus viridans (6), Pseudomonas (2), and Legionella (1).

RESULTS: Twenty-three patients had mechanical and 5 had biological valves implanted during the Bentall procedure. Hypothermic circulatory arrest was used in 64%. Hospital mortality was 11%: there was one intraoperative death, and two before discharge (one cardiac, one sepsis). Eighty-nine percent survived without stroke. During follow-up (median, 44.5 months; complete in 92%), 1 patient died of recurrent endocarditis at 4 months.

CONCLUSIONS: These results indicate that prosthetic root replacement may be superior to use of a homograft for acute aortic prosthetic valve endocarditis, with only a 4% incidence of recurrent endocarditis and reoperation.




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